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Shashidhar Kusuma, MD

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Shashidhar Kusuma, MD

Shashidhar Kusuma, MD, is an ASPS Member plastic surgeon who is board certified by The American Board of Plastic Surgery®
and trained specifically in plastic surgery. ASPS members operate only in accredited medical facilities, adhere to a
strict code of ethics and fulfill continuing medical education requirements in plastic surgery, including training in
patient safety techniques. As your medical partner, Dr. Kusuma is dedicated to
working with you to achieve your goals.

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Meet Dr. Shashidhar
Kusuma

A premium surgical center and a center of excellence are both products of exceptional people. This team should be collaborative, experienced, innovative, communicative, accountable and always on the cutting edge of surgical care. This team of professionals should treat each patient as an individual and develop treatment plans that suit that particular individual's needs. The approach should never be a cookie cutter, one size fits all method. This team should also practice excellent standards of care and continuously strive to improve on a daily basis. The objective should be to obtain optimal outcomes for each and every patient.

Our vision and passion at Suria Plastic Surgery is to be such a center of excellence. With the educational background, training background, and surgical experience, Dr.Kusuma and his team are dedicated to develop such a center of excellence here in South Florida. Plastic surgery in particular is a field that allows a skilled surgeon to combine science with art, technology with technical ability, passion with creativity. Dr.Kusuma strives to embody all these features in his practice on a daily basis. He is a perfectionist by nature, and always strives to get the optimal result for any situation. He does not rest until he does so.

He is very compassionate, caring and is a very good listener. As a matter of fact, he was honored by a patient as "the worlds most patient doctor". He understands surgery is as much physical as it is emotional. He treats the whole patient.

Once he becomes the physician of a patient, he is vested in the long term outcomes of the patient. He hopes to be his/her plastic surgeon for the rest of his career. He prides on developing long term relationships and lasting outcomes for patients. He follows up with patients very closely and is always available.

In these confusing times when there are marketing claims made on a daily basis as to the superiority of a particular technology, product or technique, Dr.Kusuma relies on science, peer reviewed research, and validation of technologies, products and techniques. He believes in educating patients with accurate information, and does not profess unsubstantiated claims. A large part of a consultation is spent on patient education, so that he and the patient can decide together on the appropriate course of action

Removal of old implants & replacement

Question:

Implants are 28 yrs old. Recent mammogram shows leakage on one side yesterday, never showed before. Need advice of next steps as to how soon to remove, replace and by whom.. want the best surgeon experienced in this.

Shashidhar Kusuma, MD's Response:

28 yrs is a long time for implants to be in place. Now with the leak, you should get them replaced/exchanged. With revision surgery and implants that are this old, its important to identify any hardening, calcifications of the scar tissue, any leakage of the silicone outside of the scar tissue, the relative position of the implants, the size, shape, symmetry and other aspects and match the revision surgery to the expectation that you have. Many decisions have to be made, of course after a detailed consultation, proper evaluation, assessment and discussion of the appropriate strategy. Some times it can be a simple operations to exchange and other can be more involved. It is not urgent but should be done in a timely manner to avoid further leakage and problems.
Please visit with a board certified plastic surgeon from ASPS.

New Breast Implants after implant removal

Question:

I currently have capsular contracture and my health insurance is willing to remove them... how long should I wait until I can have new implants placed under the muscle. Looking for a surgeon who will implant under the muscle in my area.

Shashidhar Kusuma, MD's Response:

Often times with capsular contracture, removal of the implant and all of the capsule will cause release of the space that is so tightly adhered to the scar tissue. This may lead to a space that is large and hence the implant selection will have to be carefully chosen. There may need to be adjustments made to the pocket. Other times, based on your desire for a size, smaller implants may be desired in which case a lift may be needed.
Other times, creation of a new pocket called a "neopocket' may be required to precisely control the placement of a new implant. The location of the new implant can be determined based on the need, i.e under the muscle etc.
It's recently been shown that capsular contracture maybe due to sub clinical contamination with bacteria, in addition to other technical reasons. In such cases, removal of the offending scar tissue, implant and implant material is important. In such cases, it is also wise to stage the removal and replacement in 2 sessions.

Sharp Pointy Nose

Question:

I have a very thin witch-like nose. I really want to make it smaller and less noticeable. I don't want it to be the main thing people notice about me. Is nose surgery safe? Could something go wrong and make me look even worse?

Shashidhar Kusuma, MD's Response:

Hello,
Very valid concern and common with this operation. Rhinoplasty is a delicate and precise operation and in experienced hands, quite successful.

Breast Implant Illness

Question:

I have done some research and came across a video of a girl that got silicone implants and suffered severely from them. She got her implants removed and all of her symptoms were gone proving it was breast implant illness. How likely is that to happen? How can I prevent that?

Shashidhar Kusuma, MD's Response:

Hello, I have had the opportunity and experience working with many women with this situation. There has been now some emphasis placed by ASPS on the topic as there are adequate women who have reported this condition. While there is no hard evidence to support or refute this condition, I believe that there is something there. With present day technology, it is not possible to screen patients for this condition. The percentage of women who experience this is however very small relative to the overall women with implants.
Of the many cases where i have done implant removal, some have improved and others haven't in my cases. Many have been thankful and relieved that they have eliminated another possible situation that may cause this problem.
As we continue to study this problem, I am sure there will be more we will learn in due time.

post breast augmentation complication capsular contracture

Question:

My left breast implant hasn't dropped, 3 months post surgery. It remains very high, about 2" below my clavicle, becoming deformed looking, and is more uncomfortable as days go by. Surgeon says it definitely needs revising surgery, but won't touch it till it's been 6 months. I don't see waiting another 3 months, when it's embarrassingly unsightly, and uncomfortable. What to do?

Shashidhar Kusuma, MD's Response:

There are a lot of questions that will have to be answered which you and your surgeon know. Was this a revision case? was the placement under the muscle or over the muscle?, was there asymmetry (one larger than the other, droopier than the other) of the breasts prior to surgery? were the implants of the same size?( can have an effect on how they drop and how much, what incision was used? (some times placement can be difficult when done via the nipple/areola and or the armpit vs an incision in the breast fold, was a lift done at the same time? is there a distortion of the shape of the breast? and many more questions will need to be better understood.
While the high position maybe malposition based on what your describe, but increasing pain could be contracture even at this early stage.
work with your surgeon with regular follow ups and time the appropriate course of action, i.e revision, or other conservative measures.

How safe and effective is blepharoplasty?

Question:

For under the eye bags, can laser surgery be done? What are post op issues to deal with. What are risks? How natural do the results look?

Shashidhar Kusuma, MD's Response:

Blepharoplasty as many other operations is an effective and safe operation. Generally the lower eyelid surgery is a bit more delicate than the upper as the issue can be the pull of the lower lid. Conservative approaches are usually best. For bags under the eyes, sometimes you can add some fillers below to help the look for most cases, removing or repositioning the fat in the bags works well followed by some fillers to make the area look better. At the same time a very conservative amount of skin can be removed or in some cases non surgical skin tightening can be done with chemicals, or lasers.
In safe hands this surgery is safe and effective. WE are learning in cosmetic surgery, combination treatments usually work best where you use various techniques to include some surgery, some skin improvement work and some volume work.

Nose job??

Question:

How do I know if a nose job is right for me? Also I would love to have one. I hate how far my nose sticks out, but don’t want a huge dramatic change

Shashidhar Kusuma, MD's Response:

Nose surgery or some procedure to improve the look and in some cases the function require an in depth analysis of the face and relationships of the face to the nose etc. In some cases minimal work maybe required, in other some major surgery. The concerns that you raise to ensure that the right procedure the right analysis and the right execution for the problem are all things that have to discussed, analyzed, explained and executed properly.

Breast Reduction and tank top lipo

Question:

Hello , I want to get a breast reduction and a liposuction of the underarm and bulging surrounding area. Would you recommend to have both procedures done at the same time or do the breast reduction first and later on do the liposuction. Thank you in advance for your response.

Shashidhar Kusuma, MD's Response:

It is possible to do both at the same time. While a breast reduction maybe covered by insurance if you qualify based on their criteria, the lipo contouring may not be covered. Good Luck

Dont know what to do!

Question:

Im 33 healthy-Size 34-36dd. Lost/gained 40+ lbs several times. Had sag but no extra skin. Now-can almost fit in 34c but w/ "overflow" & ALOT of extra skin-1.5-2 inches +/-. Read about both lift &reduction. Cost shouldn't be a main focus-but it's a factor. I want them lifted but still at a d "ish"...mostly care about lifting. Which is less expensive and with least amount of scarring?

Shashidhar Kusuma, MD's Response:

Hello,
It appears from your description that you will need an augmentation and a lift. This is a fairly common concern for many women, especially when losing weight. This will increase the volume, remove the extra skin and shape the breast. In such cases one needs to consider the Shape, Size, Symmetry and Scar. It is always on the surgeon's mind to accomplish all this in the best and safest way possible. When there is need for volume, improve shape and correct symmetry and it seems that you are one such patient, the incisions needed to accomplish this might require an anchor scar or a variation of that.
I wish you luck

Breast Reduction

Question:

How many breast reduction surgeries can a woman have, and do the insurance company have a wait time before another breast reduction surgery be performed?

Shashidhar Kusuma, MD's Response:

It usually is unusual to need more than one reduction. Having said that if the first reduction has not been adequate and based on the symptoms, another can be justified, The second operation will be and should be judged independent of the first and based on the criteria set forth by your insurance provider and the analysis of your surgeon.

Do I need to remove implants?

Question:

I had implants inserted in 1996, saline size 36 d
I want a breast reduction do to back issues. Do I need to replace implants for reduction or is there a less painful way

Shashidhar Kusuma, MD's Response:

Based on how much smaller you want to be and how big your current implants are, you can either do a reduction of breast tissue if you have some volume to reduce of your native breast tissue and also reduce the size of the implants to get an overall decrease in size and comfort and look.
If you want to remove the implants all together, then a reduction/Lift will be needed. Often times when implants are removed after a long time, the shape of the breast will needed to be addressed. You will also have to discuss removal or not of the scar tissue or capsule as well. Some prefer to leave it alone and some prefer to remove that as well.

Questions

Question:

Hi Surgeons , I Was Interested In Getting A Breast Reduction Like I Am Really Scared Of Getting Put To Sleep Like What Are The Risks Of A Breast Reduction ? What Are The Death Rate Of A Breast Reduction Surgery ? How Long Will I Be Asleep For The Surgery ? How Long Would I Have To Be On Bedrest After I Leave The Hospital ?

Shashidhar Kusuma, MD's Response:

It is a common source of anxiety for many patients. Breast reduction is one of the more common operations performed. The general satisfaction rate is very high. The general risks of such a surgery are typical as with other operations and can include incision or scar separation during the healing process (which heals well), possibility of a hematoma (bleeding under the breast, but very uncommon), possible infection (very uncommon), asymmetry, nipple sensation changes etc.
The risks of anesthesia are as with other operations and can be explained by the anesthesiologists. Typically a breast reduction can take anywhere from 2 to 4hrs. It is an outpatient procedure, meaning you can go home the same day of the surgery. WE encourage patients to walk and move around the same day and continue to move about actively. No reason for bedrest, but light activity is best. Patients can go back to work in about 2 weeks or less and most are back to full activity by 6weeks

Inverted Nipples

Question:

Can the areola be fixed during breast augmentation surgery to be equal to the other breast? Is there a procedure to fix inverted nipples or does that all fall under breast augmentation?

Shashidhar Kusuma, MD's Response:

During any breast surgery, several things can be done at one time if necessary and agreed upon. Sometimes in mild cases, an augmentation can improve the nipple projection. In more severe cases, more needs to be done and can be done at the same time as the augmentation. As mentioned by the other surgeons above, if there is any issue with asymmetry of the position of the nipple/areola or the size, those can be addressed in which case it would be considered an augmentation and a lift. A stand alone augmentation does not correct such asymmetries. It only adds volume.

Labiplasti

Question:

I want to get a labiplasti i was born with an enlarged labia and don’t like how it looks and it’s uncomfortable for me to wear bathing suits, have sex, or just feel normal when i search plastic surgeons in Lexington KY i don’t see anybody who does this procedure so just wondering if anybody knows a good surgeon who does it?

Shashidhar Kusuma, MD's Response:

I have also noticed that only a few practices list feminine surgery or specifically labiaolasty listed prominently on their outlets like the website, social media , print media etc.
Most ASPS surgeons would be very competent to perform this procedure. I encourage you to call and specifically ask the office about the procedure.

Nipples/areola

Question:

Is it possible to reduce the size of the nipple, well areola without losing sensation?

Shashidhar Kusuma, MD's Response:

As stated above, change in sensation might happen short term. The change in sensation usually is minimal when doing limited work such as making the diameter smaller without moving the location of the nipple/areola complex due to sagging etc . Even if there is a change, it will likely return to a baseline level over the course of time upto even a year.

Tattoo removal Part 2

Question:

I am writing in again because I did not see an area to reply to the surgeon that answered my first question. My tattoo on my finger is an inch both ways, so very small. It is only black ink. It is an outline of a heart with an initial in the middle and I have had a couple other tattoos removed before and none of them have been this hard. I have had 13 sessions on this . What would surgery cost?

Shashidhar Kusuma, MD's Response:

Similar to the response to the first part, I would encourage you to try a pico laser for this. If you have given up on the laser strategy and if you are comfortable that a pico type of laser was used and it still didn't work and you are now committed to surgery, this is something that can be done in the office setting under local anesthesia. On a finger, that amount of skin removal might need a graft or a some more elegant work to reconstruct. The pricing will vary based on the number of stages and where it is done such as an office setting under local anesthesia, or a surgical center under deeper anesthesia . The recovery and post operative course may also be long and should be discussed.
May cost $3000 or more.

Tattoo removal

Question:

Hi there. I was told that it is possible for a plastic surgeon to remove a tattoo. I just scheduled my 14th session for my finger. I have had a couple tattoo removals before and surprisingly, this one out of all of them, has been giving me the most trouble. It is on my finger and I am wondering how much something like that would cost to remove? It is about 1 inch both ways

Shashidhar Kusuma, MD's Response:

A 1x1 inch tattoo on a finger is a large tattoo. Doing a surgical removal while possible, may not be the best strategy. As Dr. Law indicated above, perhaps the type of tattoo removal laser being used is not ideal. I would encourage similarly to identify the right type of laser. Pico lasers are usually best and black ink is fairly common and very treatable.

Knowing how big to go

Question:

Hi I'm a 25 year old i am 5/7 and 140 pounds I have a 2 year old and when I was pregnant I went from a cup to d cup after I had her i went back to a small a cup and I want to go back to having bigger and more fuller breast

Shashidhar Kusuma, MD's Response:

Many times the volume of the implant is used as the main conversation when referring to the appropriate or ideal size. Instead, the better conversation is to understand with the help of your surgeon the ideal size for you based on measurements of your natural breast, the skin tightness, laxity, the expectation of size, the overall look etc. Frequently, the Shape, Size, the Symmetry and the Scar all have to be discussed in detail and this will vary from person to person. This can only be done to some extent virtually, but the best with an in person consultation and detailed discussion.
A lot of this is science, but also art and judgement. As Dr.Law stated above, once a good detailed consultation is done, the surgeon will have a very good idea of what type, size implant to use.

Board Certified???

Question:

By many recommendations I chose a plastic surgeon for a mini face, neck and laser procedure but when I went on line to check if he was ASPS, no name was found. One of the reps at my inquiry said that not all doctors register. If so, how do I find out about his credentials??? Is a mini face life, neck lift and a facial laser painful?
go

Shashidhar Kusuma, MD's Response:

One way to find out is to simply ask the office, check the ASPS site, ABPS site. Look for the logo on the website for ABPS and ASPS.
Mini facelift, neck and laser work can be done under local and or Local anesthesia and IV sedation. The discomfort can be well managed with a good peri operative pain management strategy.

Making breast augmentation appear natural

Question:

I had my first breast augmentation in 2017, however, after 9months, they still haven't "settled" or looked natural, how I was told they were going to look, so I underwent another 30 min procedure at the time to try to "lower" the implants. It has been 6 months, and they still haven't settled and have an "arch" at the top of my chest..is this normal? Any exercises I should be doing?

Shashidhar Kusuma, MD's Response:

Hello Brittany,
It appears that this is a pocket problem and also sagging of the breasts over the implants and hanging lower than the implant. It is true that over time implants do settle provided that the pocket dissection is good.
In a case like yours it seems that you might need a revision of the pocket and or a lift of the breast tissue. This is ofcourse assuming that there is no hardening of the breast from the implants.
This is a very high level guess based on limited information. I recommend that you get a very thorough evaluation and discussion to determine the problem and have it corrected.

Infection prevention

Question:

Is there anything I could/should do pre surgery to lower my risk of infection?

Shashidhar Kusuma, MD's Response:

Managing the time around surgery called the peri operative period will lead to good outcomes in most cases. As for surgical infections generally speaking, ensuring that you are optimally prepared by adjusting your meds, your diet and your over the counter regimen is important so there are no issues in surgery. Giving one does of pre operative antibiotics prior to incision, atleast 30 minutes prior is important. Ensuring that full sterile technique is followed in surgery is important. Making sure that the surgery is done meticulously without much bleeding, or other tissue harming things are done is important. Ensuring that proper post operative care is taken with good rest, good incision care, good functional activity to ensure that no additional stress is placed, avoiding animals, etc are all important to ensure that infections are minimized. The incidence of infections in elective cases is very low to begin with.

Mini facelift

Question:

To learn how many mini facelifts have been performed do you ask the surgeon or obtain a report from a database.

Shashidhar Kusuma, MD's Response:

There are a lot of variations, degrees of complexity of the actual work done, proper analysis of the problem and expectations to be evaluated , the short , medium and long term results to be considered , non surgical vs,. Surgical options and so much more that has to be also discussed.
Moreover the quality of the result is so much more important than a named procedure such as a mini facelift. Many times it’s hard to know what one means and what one uses such terms.
As the other surgeons have said , it’s important to meet, discuss , analyze, the actual problem vs. a procedure as many times other strategies will be considered, options discussed etc.
I recommend that you get comfortable and build trust with a surgeon, an office and discuss the wishes and problems and let them give you recommendations of what procedures or treatment options are best for you.

Full body liposuction

Question:

To do full body lipo, what are the requirements?

Shashidhar Kusuma, MD's Response:

Logistics to do a full body on the table take a lot of time. Positioning, repositioning, preppeing, reprepping , anesthesia time etc. Also the volume needed to inject and remove has to be closely monitored. Fluid management is critical. Body physiology needs to be closely monitored. Too long on the table is also not safe due to blood clots etc.
So, full body is not a good idea. There are patients who may have issues all over the body but are small and very manageable in nature. In such cases it maybe be mostly contouring and fine tuning that is minimal and hence something that can be discussed.

Burn treating

Question:

I have burn 3rd degree B in the face and chest hands and back I was in Germany for 2 years but I’m not good yet I think I’m worst now, can you advice me for best burns center in USA , I will be thankful for your time.

Shashidhar Kusuma, MD's Response:

Hello,
It appears you are now dealing with the scar contractions and functional problems, aesthetics from the unfortunate situation you are dealing with. This is mostly reconstructive surgery and doesn't necessarily need a burn center where acute injuries are managed. A well trained plastic surgeon should be able to help guide and mange this situation. There is a Cleveland clinic in Abu Dhabi with a plastic surgery division. You can consider visiting there.
I wish you well.

Will a transfer of fat to the hands help improve crepey skin?

Question:

I appreciate the earlier answers. What I'm wondering is whether fillers, whichever is used, will help fill and reduce the crepe or will it simply look like plumper crepey skin? Thanks.

Shashidhar Kusuma, MD's Response:

The fillers will certainly help. You can also improve the skin itself by doing some laser resurfacing with a fractionated non ablative laser (for example Resurfx by Lumenis) or some similar device. This laser resurfacing will help improve the architecture of the skin itself while the filler will plump up the lost volume.

Excess skin removal after extreme weight loss

Question:

Where is the incision scar after having the “High lateral tension abdominoplasty”? Does this surgery remove excess skin from the abdomen, and the thighs about halfway down the thigh? About how much time does that surgery typically last? Thanks!

Shashidhar Kusuma, MD's Response:

High lateral tension abdominoplasty does improve the lateral thighs a little but it is designed to give the lateral area, the flanks, a much better look. It certainly does not effectively address the thigh half way down the thigh. The surgery can last around 3 hrs in most cases. There can be some variability in times but that is the average. Some of this may vary by the actual purpose and design by the surgeon and how it is done and what discussions and needs the patient has. Many times, such cases can be customized and not necessarily cookie cutter and standard. There can be a lot of variability in the execution of the procedure to tailor it to the patient.

Breast lift

Question:

Hi, I had a breast lift. I can’t find a bra that fits in the cup area. I didn’t want to get implants. Can I get fat transfer in my breast to go up a bra size?

Shashidhar Kusuma, MD's Response:

You can absolutely undergo fat grafting to the breast. That is assuming you have some fat to harvest. If very thin, it can be difficult to get adequate amount to make a difference. Fat grafting has dual advantages. The areas where the fat is harvested will look better and assuming that the fat that is injected survives, can give you more volume in the breasts as well.

Arm lift

Question:

Hi, after major weight loss. I had a arm lift, tummy tuck, & breast lift. Arm lift not appealing was done on the back side. I was left with big scars. It feels like tight bands that inhibits the movement of my arms. Can I get a scar revision to help my arms to look nicer & help with movement? My tummy tuck was left with a pooch. Can I get liposuction in that area? so it be flatter.

Shashidhar Kusuma, MD's Response:

Hello Sunshine,
In general, yes, you should certainly seek an opinion on improving your outcome for both the arms and the abdomen. What can be done to improve the scar (revising the incision, lasers, topical treatments, physical therapy) etc. can be discussed. Similarly for the abdomen, you can determine if that is skin excess and or fat that can be removed. Sometimes non-surgical skin tightening alternatives can also be used to address some things in such cases. Weight loss surgery patients many times do need revisions as the nature of the fat and skin change and sometimes, wound healing is not optimal. The skin can also become relaxed after surgery after a period of time unfortunately. But relatively speaking, many patients are very happy with the overall improvement in their appearance.

Pricing

Question:

How much would a breast implants be

Shashidhar Kusuma, MD's Response:

Hello Traci,
Pricing for services are very geographic in nature. They also reflect the type of practice. For example, there are surgical centers in big cities that offer breast augmentation for $3000. However, in such centers, someone sees the patient, someone else operates, someone else follows up etc. etc. Many times, there are specials that many offices offer at different times of the year. But on average, it is best to check the ASPS website for average pricing in your geographic area. I would recommend consulting with an ASPS board certified surgeon and make sure that you feel comfortable with the office, the surgeon, the plan, the price. It is very important to build trust with the care provider, the office staff and generally the entire package and long term follow up.
The average price around the country generally is around $5000 for most reputable offices.

How old do you have to be and will insurance cover it?

Question:

My breast hurt my back etc

Shashidhar Kusuma, MD's Response:

The usual age for what I believe you are asking about, a breast reduction due to size of the breasts and hence the back and neck pain, is after puberty. That age is about 16 to 18 or so, but is case dependent. The insurance process is very cumbersome and problematic and usually is based on a history of conservative treatment, weight loss, therapy etc. Even then it is based on a formula based on height, weight, presence of rashes, failure of other management etc., that doesn't suit every situation.
So, yes, in some cases insurance covers it and in many others it doesn't.

Will a transfer of fat to the hands help improve crepey skin?

Question:

I've lived in Florida my entire life. Despite using sunscreens faithfully, the skin on my hands and arms has become crepey. Can a fat filler help diminish it? Can it be used on the forearms?
Thank you.

Shashidhar Kusuma, MD's Response:

Many products can be used for the hands. These include radiesse, hyaluronic acid products and also fat. Fat grafting can generally be done in many parts of the body. It is a great technique and has come a long way. Science is getting better everyday. We have seen improvement in the skin with fat grafting as an additional feature in some cases. So, yes, fat can be used to graft hands. As always many factors need to be considered in long term outcomes, the quality of the fat, the longevity etc.

Awake during Breast Lift

Question:

Can a breast lift procedure be performed under local anesthesia?

Shashidhar Kusuma, MD's Response:

Breast surgery can be done well under IV sedation augmented with local anesthesia where you don't have to put a breathing tube in patients, or under standard general anesthesia where you do have to put a breathing tube. Doing small things under local anesthesia is also possible in select cases but proper patient selection is very important.

Breast augmentation scar revision and going larger

Question:

Hey I had a breast augmentation in 2014 ended up bottoming out. Had 375 under muscle! My ps told me it was because my tissues were soft! Later had a revision and did not heal correctly ! Saw him today and recommends not fixing scars and not going bigger! I’m looking at 450/500! What are your thoughts on this and is there anyway I can attach a photo of the scar!

Shashidhar Kusuma, MD's Response:

I would agree with my colleagues above. It may also be that sometimes, the pocket maybe too lateral, too big etc. In these cases an assessment needs to be made to see if the implant is positioned properly and is of the right size for the breast. Sometimes the pocket needs to be changed and a lift done at the same time to revise the whole situation. Sometimes focusing too much on the volume is not the right solution. For this situation, doing a detailed consultation is very necessary.
As for photo upload, I don't believe that this site offers that feature yet. Would be very helpful though.
Many of us do virtual consults as well.

Implants

Question:

If I want to stay the same size but want a lift do I need implants?

Shashidhar Kusuma, MD's Response:

Hello,
when a patient doesn't have enough volume, especially at the upper part, but has droopy breasts and nipples that point down, even a lift while it repositions the location, still won't be enough to give a good outcome in some cases.
so, sometimes patients need an implant to help with this. The size change hopefully can be minor based on adjustment of the breast tissue removal etc.
This can be discussed in detail during a conversation with a surgeon.

Mini tummy tuck

Question:

Thank you all for this site, I was referred here by a Plastic surgeon from the orlando VA. I had a consult in NY for a MTT but had to move on short notice,from looking at my profile pic can I get a ballpark cost for this procedure after which I can choose and schedule a consult. I really do not want to book multiple consult just to be told a price beyond my budget. Thank you all very much.

Shashidhar Kusuma, MD's Response:

Hello Grace,
pricing is very geographic. In miami, pricing is very different than in fort lauderdale. Also, it depends on the type of practice as well.
But you should be able to get a general ball park figure. It can be about $5000k on average in our geographic region if that is truly only what you need. Many times after a real consult, many things maybe discussed, other things may surface etc. so you should keep an open mind. The most important thing obviously is to identify a surgeon and an office that you feel comfortable with, you trust, the consultation and recommendation make sense.

How do you know if your stomach fat is visceral or over the muscle?

Question:

How do you know if your stomach fat is visceral or over the muscle, as far as being a good candidate for liposuction?

Shashidhar Kusuma, MD's Response:

Yes, a great question. A pinch test of the skin and fat, an experienced surgeon's examination, BMI measurement, caliper based body fat measurement, CT and or MRI are all good ways to determine the difference.

uneven breasts following surgey

Question:

I had breast reduction surgery with a reputable board certified plastic surgeon a month ago .When the bandages were removed I was horrified to find out that the breasts are very uneven.The right breast is visibly larger.Also the scar on the right is much higher on the breast When I discussed it with the surgeon at first he didn't answer then he made excuses and brushed me off.I am devastated.

Shashidhar Kusuma, MD's Response:

Hello Gracie,
While I can empathize with this situation, i also believe that most surgeons would value obtaining the best results possible. From the information you posted, it appears that you are very early in the phase of healing. As long as the immediate concern of bleeding or fluid collection is ruled out, which i assume already happened, the best thing to do is to wait a short while (3 months or so) and continue to discuss a revision to improve the situation with your surgeon. I would imagine as I said that most surgeons would value optimal results and would work hard to achieve them. I know that there could be some cost implications, but these are the sensitive matters I hope you and the surgeon can discuss in a transparent, mutually understanding way.

Um boobs?

Question:

I’m 16 with size 40DDD and I weigh about 129 pounds and iv been recommended by my doctor to look for breast reductions and a few parents have also said the same thing, can I get a breast reduction at 16 in florida with a parent consent?

Shashidhar Kusuma, MD's Response:

Hello Naomi,
Yes, you are a candidate for a breast reduction. I would assume you haven't had further maturation, growth recently and have been stable in your size?
However, a breast reduction will vastly improve your quality of life.

Documentation needed?

Question:

Hello I mean 38 f and I just recently went to my primary care doctor about my back and neck pain he referred me to a surgeon for a consultation when I called the lady who schedule appointments she advised that I would need to show proof from doctor and chiropractor that this is necessary before I can get a consultation is this accurate I have UnitedHealthcare or should I find another surgeon

Shashidhar Kusuma, MD's Response:

The more supporting documentation you have, the better your chances will be. However, many of us surgeons have become very disillusioned with insurance companies. This has become a game where the insurance companies now use very cumbersome protocols to go through the process all the while without any desire to approve a procedure. This almost seems to be by design to deny authorizations, make the process onerous and painful, and discourage patients and physicians from being successful for such procedures. They often attempt to create antagonism between the patient and the physician by giving hopeful information to the patient and different information to the physician's office.
Having said that, I emphasize the point that the more physician, physical therapy, chiropractor support you have, the bette your chances will be.

Is it possible to add the nose bridge?

Question:

I have seen a lot of pictures of nose job but every one has had a bigger nose fixed to smaller ones. But I have a flat nose and want to add nose bridge.How much will the whole procedure cost me?

Shashidhar Kusuma, MD's Response:

I agree with Dr.Aronowitz. For augmentation of the profile or the dorsum, doing minimally invasive, non-surgical techniques are a good and reasonable options. Using short term fillers such as restylane and juvederm or longer term fillers such as bellafill work well. I have done several of these. These work well for isolated depressions to further refine the nose. Patients have been happy with such minimally invasive options,.
Surgery can always be a good option. For augmenting the top of the nose, usually, cartilage is harvested either from the nose or from the rib and used to augment as a permanent graft to give more projection to the nose.
Just as everything else, a good detailed conversation and consultation should help guide you the right way.

For my daughter

Question:

My daughter is 17 and she would like to take the fat from her stomach and move it to her hips and take some of the fat from her thighs and move it to her breasts. If I give her consent as her mother does she qualify for this procedure?

Shashidhar Kusuma, MD's Response:

Generally for thin patients, the amount of fat needed to do primary augmentation is not sufficient and may require more than one session. So this depends on the amount of augmentation needed and the amount of fat available. Using fat for augmenting other areas is a good solution. This has the dual effect of contouring the area that the fat is harvested from as in lipo contouring and also has the potential to improve another area of deficiency.
The age is a matter where it would need to be discussed with the parents, see the maturity level of the patient, and also the long term goals and life choices of the patient. At this age, the reproductive life cycle, the weight gain and loss possiblities etc. will have to be discussed carefully as these physiological changes may affect the outcome.

keloid

Question:

Dear Dr, I am a 21 yo lady, I have a keloid in the upper part of my chest, just on sternum, I did 2 times injection of depomedrol, it's very painful and it's still there.
Is there any new treatment to cure it.
Best regards

Shashidhar Kusuma, MD's Response:

Tough problem but manageable. I’ve had moderate success with excision and injection of steroid starting the day of surgery and then close folllow up every 2 to 3 months for examination and ongoing injections of steroids as needed. This helps modulate the recurrence to some degree. As the other surgeons suggested, radiation at the time of surgery is best.

Fat transfer results

Question:

Hello. I am considering a breast augmentation. I have breastfed 2 children, and now hat I’m done I’m ready to get my body back. My breasts are very deflated, and I would like a complete overhaul (make aeriola smaller, lift, better shape, the works) will I be able to get my desired result through the fat transfer stem cell method, or would I need implants and lift? I’m nervous to have implants

Shashidhar Kusuma, MD's Response:

Hello,
I believe that consulting and understanding more thoroughly and with proper context and data can help alleviate or at least clarity any fears about implants or surgery in general. As to the question about fat transfer vs. implants, while it is possible to add fat to improve the fullness, volume deficiency, correct any asymmetry to further improve the outcome, it can be difficult to do a primary augmentation with fat grafting alone. This will clearly depend on the volume needed, the skin laxity, the expectation of the size desired, the quality of the fat etc. There also may be a need to do a few sessions.
Moreover, stem cell transplant is over marketed as to the stem cell component. While there are fat derived stem cells , there is no guarantee when doing high volume that we can inject stem cells, how many, etc. While there are huge advantages to work with Stem cells and stem cell science is getting deeper, we are quite where we want it to be yet. Promising future!!!

Hairy Nevis

Question:

My daughter has a large hairy nevis on her arm about the size of a quarter. She’s ten years old and asking questions about removal. The derm said due to the size to use a plastic surgeon. Do I need to find a specialist? What does the process include?

Shashidhar Kusuma, MD's Response:

A size of a nevus you describe can be removed in one stage likely. If not, it can also be done in stages. Due to your daughter's age, it is best done as an outpatient in a surgical center with some anesthesia. The post operative course can take upto 6 weeks before resuming normal activity, so timing is critical so as not to interrupt school activities.
The incision line needs to be watched to ensure optimal outcomes. May need scar management, laser resurfacing later to improve if needed.

Brea

Question:

I am being told by my Dr after my visit that he can only do a complete nipple grafting on me because of the size of my breast. Mentally i wasn't looking forward to this method because i wished to retain some probability of breastfeeding. Please do i have other options? Been feeling so depressed about this. Please any advice?

Shashidhar Kusuma, MD's Response:

I would agree with Dr.Amspacher. In most cases, reductions can be done without nipple grafting. In the extreme cases and outlier cases, that maybe necessary, but even in those cases, it is worthwhile to get a few opinions and attempt a reduction without grafting.
'Wish you well.

Diabetic

Question:

Can a diabetic have a successful tummy tuck surgery...

Shashidhar Kusuma, MD's Response:

Of course Lisa. This is where the preoperative medical assessment and clearance process, education, proper intra operative execution of the procedure and anesthesia management, and meticulous post operative management will speak loud. This has to be a partnership among the surgeon, the patient and the primary care and anesthesia professionals to properly collaborate and manage the patient.
There are many patients who present with many situations. A well trained surgeon, with a well trained team and staff, and a compliant and diligent patient can go through this process very very successfully.

Is a Redo Possible?

Question:

I did my upper arm lift in Turkey some years ago. Unfortunately it was not done properly. Is it possible to redo it

Shashidhar Kusuma, MD's Response:

the general answer is yes. Was it not done properly as in, not enough skin removed?, or too much removed?, the scar is not optimal?, or the contour is not right? etc. etc.
i encourage you to seek consultation with a well trained ASPS member surgeon to provide you with a proper evaluation and choices of solutions.

Facelift with necklift

Question:

I am 64-year-old, healthy female looking primarily to eliminate a turkey neck. Would a lower facelift be needed in conjunction with a necklift to accomplish this?

Shashidhar Kusuma, MD's Response:

Generally speaking in order to improve the contour of the lower face and neck , since this area is a three dimensional contoured structure , the lower face and neck both would be a component the enhancement. I generally recommend doing what we call the lower face and neck lift . There are certain circumstances where you could isolate just the neck or isolate just the lower part of the face, but that depends on the degree of the problem. This will require a detailed discussion of the goals, expectations, and discussion of limitations along with the longevity of the outcome and need to obtain natural results.

Possibly septoplasty problems?

Question:

There is a septoplasty info page on this site but I can’t ask a question specifically about it so I don’t know if it’s ok to ask here, but I think after my septoplasty I’ve had a problem where my nose at some times will hurt even if barely touched or pushed on.It’s not a constant thing but this has only occurred after the surgery even though it’s been maybe 6 months I’d estimate since the surgery.

Shashidhar Kusuma, MD's Response:

Hello Silini,
sometimes during a septoplasty or a septorhinoplasty, the incision line may have an ingrown hair, a localized stitch abscess, or a localized granuloma/inflammation, or abnormal scarring that can lead to some vague discomfort. Also there could be an unidentified problem with the septum, septal perforation, raw exposed mucosa or cartilage or bone that can lead to ongoing to vague discomfort or pain. These should be further investigated with a good exam and sometimes endoscopically to see what is going on.
It is unusual to have pain this far out of surgery.
You should seek out more guidance from your surgeon and a proper evaluation from your surgeon.

Revision possible pocket displacement?

Question:

I had initial surgery in 2005 mentor smooth saline under the muscle shortly after got capsular contracture had another surgery to fix left breast since getting the implants I’m always sick my right breast looks so much smaller than left and when I bend over they don’t stay rounded more so cone shaped what could the issue be and is it covered through warranty if not rough estimate?

Shashidhar Kusuma, MD's Response:

Hello Brittaney,
Every surgeon might have a strategy to work and improve on various aspects of breast issues. As long as the results and outcomes are consistent in the hands of the surgeon, different strategies might be good to listen to and understand.
In my hands, when there are large pockets, lateral displacement of implants, or not enough cleavage, capsular contracture and various other pocket related issues, I prefer to start new. I prefer to use a NEOPOCKET, where I create a new space above the old scar tissue or capsule and control the dissection as precisely as possible and position the implant where I want to get the best shape possible. If there is skin laxity, or nipple position issues etc, then you can do a lift at the same time. In general, it is best in my opinion to have the same foot print of the breast or as close as possible. So, I try my best to have the same volume, size of implant etc to gain consistency in outcomes.

Concerned

Question:

I had a breast job done several years ago and had 375cc of saline implants put in and now I went to 450cc of silicone. I think the dr. Just lifted my breast to make them equal and did not put in the silicone implants and left the saline ones in. How can I tell if I still have saline implants or if he really put the silicone ones in? FYI, my breast are the same size they were!

Shashidhar Kusuma, MD's Response:

Hello Michelle,
In some cases a clinical exam from a trained surgeon can be useful, but an MRI would be very useful to determine the type of implant. You can ask for the implant card of your implant from the surgeon. That will also indicate the type, size etc. of the implanted implants. The operative record and the nursing records will also indicate what type of implants were used.

Mobile Engagement of Patients

Question:

Shashidhar Kusuma, MD's Response:

The future of medicine is about patient empowerment, engagement and customized mobile centric communication points along the point of care. Long gone are the days of mass emails, and generic announcements. It is about precision medicine not only in clinical care, but precision communications and customized engagements relevant to the individual on demand, on point, contextual, relevant and real time.
Look into Symplast which is systematically changing and leading this paradigm shift. This platform has a powerful patient app that is engaging, immersive and simple to use that facilitates such real time communication that is customized.
Lets embrace these powerful enabling technologic enhancements and move away from 100 year old thinking about the way we have taken care of patients.
Great suggestion @jacques. Symplast is working on strong relationships with the vendors of products to help with this type of communications..

Lipo under the chin?

Question:

I have some cheek and chin/neck fat that won't go away unless I become dangerously thin. Amongst other things I'd like done on my face, this is one that bothers me the most, especially when it comes to other people taking photos of me. Would liposuction be the best option, or is there another procedure that would suit better? I've heard about fat transfers/grafting, is that viable?

Shashidhar Kusuma, MD's Response:

As my other colleagues have recommended, there are options: Kybella, Thermi tight, or other non surgical energy based treatment for limited issues, or a small incision under the chin and direct removal of fat and limited skin dissection without resection. There is literature to support that direct excision with a small 3 to 4 cm incision under the chin and limited skin elevation through the same incision can provide the decrease in fat and also skin contraction to some degree in younger patients with limited issues. Otherwise a comprehensive neck lift also is a good solution for more moderate to severe issues.
Fat grafting would not work here as you are concerned about fat excess here.

Mommy makeover

Question:

Is if safe for a person have a breast lift, tummy tuck,liposculpture and fat transfer all at once?

Shashidhar Kusuma, MD's Response:

I agree with Dr.Baum that the time to do elective procedures should be kept to around 6 hrs. A breast lift based on the amount of work that is needed such as only around the nipple/areola, or a lollipop type or an anchor type will take different lengths of time. Also if the tummytuck is on a thin person vs a larger person, the time will vary. As such we have to personalize such decisions. Also if the liposculpture is only of the inner thighs and then fat grafting is to the face as an example, it is possible to do all these at the same time with a reasonable safe time period.
Just like golfers have different approaches to the game, while all ASPS surgeons have similar goals, the pathway to get there sometimes can vary based on ones experience, and other factors.

Cost

Question:

I'm curious as to how much an average arm lift procedure costs

Shashidhar Kusuma, MD's Response:

The pricing across the United States is variable. some surgeons price by time, some by procedure, some by lifetime value as in already factor in costs for possible touch ups, revisions etc. The costs also vary according to the needs of the patient, such as hospital admission or need to do it in a hospital vs. at an outpatient surgery center vs an accredited surgery center in the surgeons' offices. During consultation there maybe a need to discuss other aspects to get an optimal outcome. Generally speaking however, the price can vary between $5k to $10k.

Too small after Breast Reduction

Question:

I had 2 consults with my PS to be sure about having the reduction & approximate a size. However, I am still left with them being much smaller than we discussed. I was a 40H/I before the Reduction & measuring 38 D now. I am 6 weeks post op & I was expecting to be E/F cup minimum. He removed 2850grams total. Insurance only required 700grams.
What options do I have as far as a revision?

Shashidhar Kusuma, MD's Response:

In these cases, there are really 3 options. One is to do an augmentation to increase the size. The second is to do fat grafting to increase the size and the third is to do both perhaps. Each has its own merits and limitations. I hope you find the right solution for you.

Do tummy tuck scars go away?

Question:

I think a tummy tuck would make me feel a little better about getting into a two-piece bathing suit, but I don't know if a flat stomach is worth ugly scars. Do the scars ever fade or go away, or are they permanent?

Shashidhar Kusuma, MD's Response:

Things are always relative to where one starts. If the skin excess, fat excess and the overall appearance causes concerns, relative to that, a thin scar that is placed low enough is a vast improvement in the overall appearance with or without garments in general. Over long term, the incision heal well and are very acceptable to most patients.

How much pain can you expect after a breast augmentation surgery?

Question:

I've been thinking about getting my breasts enlarged for a while now, but I'm worried about the pain after recovery. All the stuff I see on the news about the opioid crisis makes me nervous about taking strong painkillers. Is the pain something I could manage with some Advil or will I need something stronger?

Shashidhar Kusuma, MD's Response:

Hello,
Breast augmentation pain depends on the placement of the implant; sub muscular or sub glandular. Generally sub muscular is more painful than sub glandular placement. Also the size of the implant and atraumatic dissection has an impact on pain. In addition managing pain before incisions are made proactively, during the surgery, and also at the end of surgery, to stay ahead of pain helps a lot. Long acting local anesthetics help manage this well. It is important to stay ahead of the pain. As soon as surgery is done, it is important to maintain consistent dosing of non narcotic meds such as ibuprofen, Tylenol and icing to manage pain. In other cases, some short term narcotics help. We have also found that using muscle relaxers for a couple of day helps especially in sub muscular placements. But in most cases, patients do very well after about 3 to 4 days.